Kladny Anne-Marie S, Zander Daniel B, Lieberum Judith-Lisa, Glatz Andreas, Brandi-Dohrn Franziska, Reinhard Thomas, Wacker Katrin
Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Ophthalmol Sci. 2022 Jul 8;2(4):100194. doi: 10.1016/j.xops.2022.100194. eCollection 2022 Dec.
To evaluate graft detachment after Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes and DMEK combined with cataract surgery (triple DMEK).
Analysis of 3 single-center prospective cohort studies and 1 randomized controlled trial.
Participants with Fuchs' endothelial corneal dystrophy.
A validated neural network for image segmentation quantified graft detachment on anterior segment OCT (AS-OCT) images 3 days after DMEK and at the 2-week postoperative visit. Area and volume of graft detachment were compared between DMEK only and triple DMEK using generalized estimating equation models and adjusting for participant age and the size of the air bubble.
Area and volume of DMEK graft detachment.
Among 207 participants with 270 eyes included, 75 pseudophakic eyes had DMEK only and 195 eyes had triple DMEK. A total of 147 eyes had less than one third of detachment at day 3. In 139 of these eyes (95%), detachment was still less than one third at the 2-week scan, indicating that postoperative graft detachment at 2 weeks occurred mainly in eyes with early detachment. When superimposing all 3-dimensional maps from 2 weeks after surgery, the central graft was mainly attached and detachment was located at the graft margin. The mean area of graft detachment decreased from 28% in DMEK only and 38% in triple DMEK to 16% in DMEK only and 25% in triple DMEK at the 2-week postoperative visit. At 2 weeks, the mean area of detachment was 1.85-fold higher (95% confidence interval [CI], 1.34-2.56) and the mean volume was 2.41-fold higher (95% CI, 1.51-3.86) in triple DMEK compared with DMEK. A total of 46 eyes received rebubbling procedures, with 7 eyes (9%) in the DMEK group and 39 eyes (20%) in the triple DMEK group (adjusted risk ratio, 3.1; 95% CI, 1.3-7.1), indicating that rebubbling was more common in eyes undergoing triple DMEK.
Automated segmentation of AS-OCT images allowed precise quantification of graft detachment over time and identified DMEK combined with cataract surgery as a risk factor. Frequency of operative follow-up might be guided by extent of detachment in the first postoperative days after DMEK.
评估假晶状体眼行Descemet膜内皮角膜移植术（DMEK）以及DMEK联合白内障手术（三联DMEK）后的植片脱离情况。
对3项单中心前瞻性队列研究和1项随机对照试验进行分析。
患有Fuchs内皮角膜营养不良的患者。
使用经过验证的用于图像分割的神经网络，对DMEK术后3天及术后2周随访时眼前节光学相干断层扫描（AS-OCT）图像上的植片脱离情况进行量化。采用广义估计方程模型并对参与者年龄和气泡大小进行校正，比较单纯DMEK组和三联DMEK组的植片脱离面积和体积。
DMEK植片脱离的面积和体积。
在纳入的207名参与者的270只眼中，75只假晶状体眼仅接受了DMEK手术，195只眼接受了三联DMEK手术。共有147只眼在术后3天时脱离面积小于三分之一。在这些眼中，有139只眼（95%）在术后2周扫描时脱离面积仍小于三分之一，这表明术后2周时的植片脱离主要发生在早期就有脱离的眼中。将术后2周的所有三维图像叠加后发现，中央植片主要附着，脱离位于植片边缘。术后2周时，单纯DMEK组植片脱离的平均面积从28%降至16%，三联DMEK组从38%降至25%。术后2周时，三联DMEK组的平均脱离面积比DMEK组高1.85倍（95%置信区间[CI]，1.34 - 2.56），平均脱离体积高2.41倍（95%CI，1.51 - 3.86）。共有46只眼接受了再次注气手术，其中DMEK组7只眼（9%），三联DMEK组39只眼（2
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